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75630 with peripheral angio

Kathy Posted Tue 21st of February, 2017 12:08:56 PM
My provider orders a peripheral angio for claudication, for a new patient and does an angiography of right leg, the suprarenal abdominal aorta w/iliac run off and then the left leg. Then the decision is make to place a stent in the femoral artery. I would use 75630-26 for the abdominal aorta w/iliac run off and 75716-26 for the legs. But, Medicare has very limited coverage for 75630, based on the LCD. My question is this- Is it ok to use I73.9 for the claudication, for the 75630-26 and 75716-26 and then use the I70.XXX code for the stent? According to ICD10 you should code to the highest specificity??
SuperCoder Answered Wed 22nd of February, 2017 05:04:54 AM

CPT code 75630 is for aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation. The provider performs radiologic imaging of the abdominal aorta and both iliofemoral arteries of the lower extremities. Whereas, CPT code 75716 is for angiography, extremity, bilateral, radiological supervision and interpretation. Both the codes represents both the technical and professional components of the service. So, need not to append modifier 26 with the codes. However, CPT code 75716 is a column 2 code for 75630, hence modifier is allowed in order to differentiate between the services provided. Use modifier 59 with code 75716 as per CCI edit rule. In addition to this, check your coverage guidelines of LCD.

Since it seems that you have definite diagnosis from the ICD code range I70.XXX (Atherosclerosis code series), so bill this series code as primary diagnosis following claudication code (I73.9). 

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